Separation Risky For Egyptian Twins

Doctors Are Not Sure Whether The Conjoined Boys Would Sustain Brain Damage.

August 18, 2002|By Denise Grady, New York Times

DALLAS -- Leaning close to the baby, her face nearly touching his, the nurse pressed a finger to her lips and tried to quiet him so his twin brother could sleep. Not about to be hushed, 14-month-old Mohamed Ibrahim flashed a devilish grin, let out a yell and stomped his feet on the mattress.

His brother Ahmed dozed anyway -- even though the boys are conjoined twins, joined at the crown of the head. Attached so closely that just a fringe of curly hair divides their foreheads, they nonetheless have separate brains and minds of their own, and they often nap at different times.

Mohamed and Ahmed, born in a remote Egyptian village 500 miles south of Cairo, have been in Dallas since June, having tests at Medical City Dallas Hospital to determine whether they can be safely separated.

Their plight is daunting. If they are not separated, they have little or no chance of ever being able to move about on their own. Because of the position in which their skulls are fused, they cannot sit, stand or crawl.

But doctors acknowledge that the surgery to separate them could kill one or both of these bright-eyed, lively boys, or cause brain damage that might cripple them, physically and mentally -- in essence, trading one lifelong disability for another just as profound.

Because of shared blood vessels in their brains, separating Ahmed and Mohamed would be even more difficult and dangerous than the 22-hour operation performed at the University of California at Los Angeles on Aug. 5 and 6 to separate the Guatemalan sisters who were also joined at the head.

"It is a challenge whether we'll wind up with two children with two good brains, or even a portion," said Dr. Kenneth Salyer, the surgeon who arranged to bring the Egyptian babies to Dallas and who is directing their care. "It's horrendous."

Mohamed and Ahmed lie on their backs much of the time, even while being fed. They cannot see each other's faces. Together they are at least 5 feet long, and it already takes two people to pick them up.

Even so, they are cheerful, squealing and bouncing with delight when visitors arrive at the apartment where they are staying in Dallas. Except for being conjoined, they are normal and healthy.

The twins' parents are in Egypt with their other children, a son, 6, and a daughter, 4. Arrangements are being made to bring the father to Dallas.

It is by no means certain that doctors will be able to help the boys.

In addition to the ethical dilemma posed by the risks of surgery, the twins' case raises questions about the fairness of spending as much as $2 million to help two children when the same amount, spent on food, vaccines or sanitation, could potentially save many more lives. The twins' medical costs are being paid by the hospital and a charity created by Salyer, the World Craniofacial Foundation.

Neither Salyer nor anyone on his team of craniofacial and neurosurgeons has ever separated twins joined at the head. The condition is so rare -- one in 2.5 million births -- that only a handful of surgeons have operated on more than one set.

The boys share some brain tissue, but Salyer said it could probably be divided without lasting harm, because very young children's brains have tremendous potential to recover from injury.

"Our concern with these twins is that the veins [in their brains] are so interdependent that separation is almost impossible, if not impossible," Salyer said.